Healthcare Provider Details

I. General information

NPI: 1134142177
Provider Name (Legal Business Name): RAKESH D MISTRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

841 STILLSON RD
FAIRFIELD CT
06824-3124
US

V. Phone/Fax

Practice location:
  • Phone: 203-623-9566
  • Fax:
Mailing address:
  • Phone: 414-405-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD071985L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberDR.0052221
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD071985L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: